LAC 40:I.4537. Maximum Reimbursement Allowance

A. Maximum allowable reimbursement for compensable professional respiratory therapy services will be based upon the lesser of the provider's charge or the allowance indicated in the Office of Workers' Compensation administration's CPT code reimbursement manual listing of medical procedures. B. Maximum allowable reimbursement for respiratory therapy supplies, equipment and related services will be the least of: 1. the provider's usual and customary fee; 2. a pre-negotiated amount between the provider and carrier/self-insured employer; or 3. the amount indicated in the maximum allowable reimbursement schedule. C. Respiratory Services Equipment State of Louisiana Office of Workers' Compensation Schedule of Maximum Allowances for Respiratory Services Equipment E0424 | Stat comp gas O2 system, rental | $455 E0425 | Stat comp gas O2 system, purchase | $4,550 | $3,413 E0430 | Port gas O2 system, purchase | $2,150 | $1,613 E0431 | Port gas O2 system, rental | $215 E0433 | Portable liquid oxygen sys | $67 E0434 | Port liquid O2 system, rental | $223 E0435 | Port liquid O2 system, purchase | $2,230 | $1,673 E0439 | Stat liquid O2 system, rental | $455 E0440 | Stat liquid O2 system, purchase | $4,550 | $3,413 E0441 | O2 contents, gaseous, per unit | $20 E0442 | O2 contents, liquid, per unit E0443 | Port O2 contents, gaseous, unit | $10 E0444 | Port O2 contents, liquid, unit | 100.69 E0450 | Volume ventilator; stat/portable | B.R. | $1,750 E0455 | O2 tent, excl croup/ped tents | B.R. E0457 | Chest shell (cuirass) | $721 | $540 | $72 E0459 | Chest wrap | $534 | $400 | $53 E0460 | Neg pressure vent; port/statonary | $9,053 | $6,790 | $905 E0461 | Vol control vent noninv int | $1,333 E0462 | Rocking bed w//w/o side rails | $3,057 | $2,293 | $306 E0463 | Press supp vent invasive int | $1,964 E0464 | Press supp vent noninv int | $2,132 E0470 | RAD w/o backup non-inv intfc | $309 E0471 | RAD w/backup non inv intrfc | $773 E0472 | RAD w backup invasive intrfc | $773 E0480 | Percussor, elect/pneum, home mod | $670 | $503 | $67 E0481 | Intrpulmnry percuss vent sys | B.R. E0482 | Cough stimulating device | $600 E0483 | Chest compression gen system | $1,485 E0484 | Non-elec oscillatory pep dvc | $52 | $39 | $5 E0485 | Oral device/appliance prefab | B.R. E0486 | Oral device/appliance cusfab | B.R. E0487 | Electronic spirometer | B.R. E0500 | IPPB machine, w/built-in Nebuliz | $1,152 | $864 | $115 E0550 | Humidifier, extensive sup humid | $526 | $394 | $53 E0555 | Humidifier, glass/autoclav plast | B.R. E0560 | Humidifier, supplemental humidi | $212 | $159 | $22 E0565 | Compressor, air power source | $640 | $480 | $64 E0570 | Nebulizer, w/compressor | $207 | $155 | $21 E0572 | Aerosol compressor adjust pr | $53 E0574 | Ultrasonic generator w svneb | $56 E0575 | Nebulizer; ultrasonic | $1,078 | $809 | $108 E0580 | Nebulizer, glass/autoclav plast | $16 E0585 | Nebulizer, w/compressor and heater | $433 | $325 | $43 E0600 | Suction pump, home model, port | $491 | $368 | $50 E0601 | Cont airway pressure (CPAP) dev | $1,172 | $879 | $117 E0605 | Vaporizer, room type | $29 | $23 | $3 E0606 | Postural drainage board | $241 | $180 | $24 E1353 | Regulator E1354 | Wheeled cart, port cyl/conc | B.R. E1355 | Stand/rack | B.R. E1356 | Batt pack/cart, port conc | B.R. E1357 | Battery charger, port conc | B.R. E1358 | DC power adapter, port conc | B.R. E1372 | Immersion ext heater nebulizer | $201 | $149 | $29 E1405 | O2 and water vapor enriching system | B.R. E1406 | O2 and water vapor enriching system | B.R.